Life-threatening toxicity after the ingestion of a topical minoxidil solution: a case report

BACKGROUND: Minoxidil is an antihypertensive drug. However, due to its adverse effects of hypertrichosis, it is a widely popular and accessible treatment for alopecia. Therefore, topical minoxidil, when ingested, has the potential for severe life-threatening complications. We present a rare case of minoxidil toxicity in a 21-year-old male in Ethiopia, highlighting a critical public health risk for easily accessible cosmetic products. CASE PRESENTATION: A 21-year-old Ethiopian (East African) male with major depressive disorder ingested 60 mL of 5% topical minoxidil solution (equivalent to 3000 mg). He presented with profound, refractory shock and tachycardia, requiring 144 hours of norepinephrine support. His course was complicated by pulmonary edema and pleural effusion 48 hours post-ingestion, managed with thoracentesis and diuretics. He did not require mechanical ventilation. After 7 days of intensive care support, he was stabilized and transferred for psychiatric care. CONCLUSION: Topical minoxidil, when ingested, can cause severe, prolonged cardiovascular and pulmonary toxicity even in young patients without prior comorbidities. Given its widespread over-the-counter availability, greater public awareness and clinical vigilance are essential. Due to the lack of a specific antidote, management requires aggressive and sustained critical care.